Depression, bias, and disadvantage

Roughly one in ten young adults have depression*, and people in all kinds of circumstances can experience it. However, people who live in poverty are more than twice as likely to have depression as people at or above the poverty level*1. The stress and stigma caused by forms of discrimination and prejudice common in American society – for example sexism, racism, classism, homophobia and transphobia -- can also increase the frequency of depression and other mental health issues and/or worsen their impact*2.

Many young adults we interviewed described relationships between their depression and other parts of their lives including but not limited to gender or sexual identity, economic circumstances, or race/ethnicity. This part of the website explores experiences at the intersection where depression meets economic disadvantage and what we are calling “bias” – that is, discrimination and hostility towards groups of people who may not fit into the categories set by mainstream society or have limited access to power and resources.

Bias and gender identity

Many people we interviewed who are women or transgender described how gender biases they encountered interacted with their depression – most often, by creating a sense of being trapped or confined by how society treats or defines them. Women said that feeling judged by boys or men fueled low self-esteem, and then depression. Sara described how in middle school she “… gained a little bit of weight… and boys would make fun of me and call me names and I would come home from school just crying all the time… I didn’t want to go to school, and I was diagnosed with depression.” Maya said the pressure on her as a woman to never rest and always be “doing something more” makes her depression harder.

Nadina lives with her parents in a suburb near a small city. She completed college and works as a freelance illustrator. She is Caucasian.

I just kind of felt like even at a young age there was a difference between boys and girls and I kind of, kind of had this inkling that people would prefer you were born a boy instead of a girl. And that made me really, just I had very low self-confidence because of that and I think what really hit me was an experience I had when I was 4 years old. I was at a daycare and I was like, they were asking us, you know, “What do you, what do you want to be when you grow up?” And I told them, “Well, I want to be a doctor.” You know, like, I, I really liked doctors, I had a female doctor, . I liked how, you know, how they made me feel better. I wanted to make other people feel better, so, you know, I said, “Oh, I want to be a doctor.” And this little boy came up to me and he was like, “You can’t be a doctor, you’re a girl.” And that really crushed me a whole lot. I was like, well that’s not true, I mean, I have, I have a lady doctor. And he’s like, “She’s a nurse, only girls can be nurses.” I mean only, you know, that’s it, they can’t be a doctor or anything like that. So that kind of [laughs] really just like made me realize okay, so obviously there’s reason why like people are telling me this. Like it must be that, you know, girls are weaker or something like that. So that kind of really tore me up and like as I was going through life I always knew that was a thing.

At that time I was also very overweight so like, being a girl, being overweight, was not a good thing, like at all. And you know, I just started to feel very uncomfortable, uncomfortable in my own skin.

We interviewed two young adults who identify as transmale (transitioning from woman to man). Both discussed various ways their depression symptoms are related to their transgender (or trans) identity. They discussed challenges in accessing competent service providers and appropriate resources. There were additional challenges associated with being able to comfortably engage in activities that would help alleviate symptoms.

Jackson works in customer service and lives in a rented house with a roommate and a cat. Ethnic background is Fijian Indian.

As a child grow-growing up, I was, like I said diagnosed with severe depression when I was 14. And it continued until about two-- maybe three years ago. It started to less-lessen actually when I came to the realization that I was trans. That really alleviated a lot of it.

Jackson says that with time he was able to understand within himself that his identity is “not wrong or freakish or anything, it's just… different,” but arriving at this place was difficult, especially while still living at his University where even the Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) community had a lot of biases.

Casey remains hopeful that achieving more of his transition-related goals (such as taking hormones or having surgery) will help ease his depression; his therapist told him that it is not uncommon for symptoms to be reduced as people are able to access resources to help them with their gender transition. But Casey also noted that despite hormonal changes related to transition he still has disappointing cycles of “feeling shitty.” He also struggles with ways that social bias and health policy made it harder to cope with his depression during transition.

Casey grew up in a rural place but now lives in a city with a roommate. He recently graduated from college and is considering graduate school while also looking for work. He is White.

…here’s another very specific trans and depression issue for people who, like me, like wear like a binder - like flatten my chest – that is painful and I, you know, I do it like safely, wear like the appropriate size but you’re not supposed to wear it for a ton of time a day and that like, that’s a huge barrier being like if I want to go outside to not experience dysphoria I have to wear this thing but it’s summer and it’s disgusting and it makes it like it’s hotter and it’s less easy to breathe and it’s like, so that’s another like, very, very annoying barrier in dealing, dealing with things.

Mhmm. Right

I remember last time…

Right because it comes into conflict some of your other strategies like of like “go take a walk outside” or keep moving or yeah?

Yeah or even just like—you know there’s also been the thing of I should like I’ll go for this walk but I shouldn’t stay out like for a ton of time because like I don’t know where in that area there’s like a bathroom I can use without being plausibly either in, in, at worst, in danger, at best, looked at as [inaudible]. You know? So that’s another category of like should I go to this event tonight? Who knows?

Bias and sexual identity

Gay, lesbian and bi-sexual young adults we interviewed described how their emerging sexuality intersected with depression. For some, reactions from parents and other adults were a significant issue. Natasha, for example, said it was easy to come out to her mother, but finds it “depressing still” that she can’t tell her father. Sierra Rose describes being unintentionally “outed” as bi-sexual by a friend. As a result, her living situation disintegrated and her mental health spiraled rapidly downward. Others talked about the stigma associated with being gay or lesbian in small towns adding to the isolation and sadness of depression. A number of people also described feeling better in many ways after they managed to move to a city or part of the country with large Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) communities and less rampant bias. A couple of people found that a “queer” identity helped them feel more authentic and less alienated.

Teri is a master’s student in family counseling who lives with her wife and a dog. She has had counseling, but not medication. She is Caucasian.

… in high school, I was starting to figure out like, “hey, you know, I’m not straight” and then so in trying to figure out what that meant, I didn’t, I didn’t want to tell anybody. and so I, I came out to my parents when I was a, when I was a freshman and they of course you know they figured I would grow out of it that kind of hurt, , but then once I felt more able to tell friends the first friend also told me. She said, “No, you’re just confused, you’ll be okay, you’ll get through it” and so it just made me not want to tell anybody else. So, I did keep it from everyone else, I felt like I didn’t fit in, all of my friends were talking about boys, and I just, it didn’t, it didn’t work, it’s not. So that was a way that I didn’t feel normal because I of course didn’t fit in with my friends, I didn’t know anyone else who was gay. There were a couple of “out” people at my school but they were not treated very well and so, of course I just “stayed in” for the most part. and then so I was not feeling normal I didn’t feel normal compared to my peers but I also didn’t feel like my normal self and when I think about how I was with seeing my family before that, I was always very much the, the peacekeeper, got along with everybody in my family, kind of the yeah, and I would make jokes to ease the tension like that kind of thing and as things got harder, I didn’t really wanna be in that role anymore. And so I found myself not wanting to spend the time with my family that I did before.

So you’re saying you isolated yourself from your family because they didn’t understand you?

Yeah that was part of it but too, I just , you know, I mean now I know some more like clinical words for this but I just didn’t find happiness in the things that I used to, so being with my family didn’t, I didn’t, I didn’t care.

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Profile Info

Age at interview:

20

Sex:

Female

Age at diagnosis:

15

Background:

Crystal is an African American college student. She works campus jobs during the year and internships in the summers.

…there are some people who find that sexuality is a big part of why they have depression or why they have trouble you know like learning more about themselves, you know identity issues and things like that and there are some people who like handle it fine. I tend to be in the category that handles it fine, sexuality has never been really an issue for me. It was, it’s weird because you know I grew up in a traditional family that and I didn’t have the vocabulary for a while to understand you know I am attracted to not just guys.

So also when I gained that vocabulary I quickly adopted and I didn’t need you know, like to go through this whole like self-discovery phase where I’m like trying to figure myself out in addition to you know figuring myself out on my depression scale and everything. I think part of that is the fact that I’m just so because I’ve treated life so transiently, I’ve been really comfortable with a lot of things. I’m comfortable with putting myself in weird situations, I’m comfortable like with my sexuality.

Deprivation and poverty

People we interviewed also talked about the reciprocal relationship between growing up and/or living in poverty and depression. As Devin summarized, “a lot of depression will come from not having enough money.” Whitney noted that having no money “made me depressed ‘cause I just can’t afford things like I want to be able to.” Several people talked about how homes of origin where resources were strained connected to an overall “bad environment” for mental health (see “Young adults’ views about what causes depression”). One person who grew up in a neighborhood with high crime rates noted that her mother protected her by keeping her indoors. As a result, she “didn’t leave the house, didn’t talk to people, didn’t have friends, didn’t have outlets” and her depression deepened.

Sierra Rose lives in an apartment with her boyfriend, another roommate, and three beloved cats. She spent a week in the hospital shortly before her interview, and was continuing with out-patient care but struggling to pay for some of it. She is Italian and Jewish.

I applied for college a couple years ago. No, a year ago and I still haven’t gone, I haven’t even continued looking into it because I see the money aspect of it, and I hear my mom’s voice, “You’ll never be able to afford that.” And that makes me realize that I’m just stuck living as a low class American the rest of my life and I don’t want that. I so don’t want that, but the voices in the back of your head, the one’s pulling you down, pulling you back, telling you “No you can’t do this, you are not good enough to do this.” That’s what the depression is to me….

Race, ethnicity, and bias

Racism and other “discriminatory events” are documented sources of stress linked to mental health issues among racial and ethnic minority groups*2 in the United States. Black people living in the United States have lower overall rates of “major depressive disorder” than non-Hispanic whites, but studies suggest they have poorer access to services, receive poorer quality of care, and are overrepresented in populations with most severe issues*3.

Many (but not all) Black and Asian young adults we interviewed spoke about their own experiences with bias or cultural norms and how these influence depression. Several people spoke about how in the Black or Asian communities in which they grew up, depression was just not “part of the vocabulary,” or was “frowned upon,” so it was difficult to go public with feelings of depression (see ‘Going public with depression’). Jeremy notes that growing up as one of few non-white children going to predominantly white schools, he always felt like “the odd person out” and noticed that “white people just ignore[d]” him. In contrast, Natasha (who is African American) says that for her, race “wasn’t really a thing” growing up, or with respect to her depression.

Maya manages an adolescent program in a community center and lives with her boyfriend. She is Chinese American.

I violate a lot of her understandings of what it is to be a good woman and because I have always been so assertive, she finds it to be aggressive and condescending. So she would always try to keep me in my place because of the Chinese sort of dynamics of hierarchy and what you can and cannot say. And I was just like, “If you wanted me to be a good Chinese daughter you should have raised me in China, because if you’re going to raise me in the United States and I’m to be successful here, I am going to take on American socialization.” Especially because I didn’t know any Asian kids growing up I was literally like, there was like me and the one Jewish kid, so we would like take our turns he would show everybody dreidels and I would show everybody like, Chinese New Year, like red envelopes and give them candy like, Chinese candies and so like, that was the extent of the diversity growing up. So not being within a culture where certain statements were normalized I think was part of the damage, but also I think there are, you know, a lot of issues and I mean this, this is part of the thing, like nobody wants to bring shame on their culture, but I think a lot of East Asian cultures have, you know, very frequent physical, emotional abuse. And I think it’s something that’s commonly not addressed because the kids do really well in school and they don’t act out, so no one sees it as a problem and I think that’s incredibly damaging. I mean there’s like an entire Reddit forum, like a Reddit sub-forum that’s just called, oh what is it, Asian parent stories. And like, there are stories of people who are just like, “I did it. I graduated from John’s Hopkins and I’m literally a brain surgeon and they’re still not happy and every day I want to kill myself.”

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Profile Info

Age at interview:

20

Sex:

Female

Age at diagnosis:

15

Background:

Crystal is an African American college student. She works campus jobs during the year and internships in the summers.

…everyone is already assumed to be mentally healthy. Everyone well I mean especially in my family and you know talking about some of these issues with other people, I have very strong people in my family tend to have very strong sense of self and a very strong sense of how we handle our own emotional mishaps. And so it’s not in our vocabulary to say, “Oh you think, you, you know, you tend to be sad consistently.” This is not really what they understand and of you do end up in that situation, they’re just like, “Well you pick yourself up and you deal with it,” Or you know, “Just be happy.” And you know it’s I really do hate the just be happy things because it’s really like first of all I really don’t want to be happy second of all how, I can’t just be now.

Right.

So just be, just being aware of the fact that you know often times families just don’t have the vocabulary for these sorts of things.

Depression, bias, and challenges for healing

People we talked to offered many examples of how bias interferes with their ability to effectively address depression. For example, people with limited financial resources described restricted access to health services of all kinds (see ‘Barriers to care for depression’), as well as difficulty finding or holding a job which could help get them out of poverty. James described how growing up in a “rough neighborhood” led to a cycle of poor education, encounters with law enforcement, limited opportunity and mental health struggles which is hard to overcome. Jeremy has avoided seeking long-term professional help for his depression in part because he feels that historically “… a lot of black people were misdiagnosed because… their psychologist doesn’t understand them [and]…mislabeled them.” Crystal said the quality of care she received while living at home was poor because her family couldn’t afford a good psychologist.

Tia works as a patient advocate. She is single and lives alone in an apartment. She is African American.

And did you get a diagnosis from your doctors who offered you that?

That’s why I did not proceed with their help because I did not want to be labeled, I did not want that in my file at all. So that’s where me had, dealing with it myself came in because I did not want to be labeled. I did not want that in my file at all.

Okay you know I, know that depression has, you know, it’s a sensitive topic and it’s in some kind of parts of the culture it’s stigmatized.

[hmm]

Do you feel that that is a stigma? Yeah and in your culture particularly?

Yes, yes it’s not something that’s easy to talk about. I feel like African Americans or maybe woman I don’t know, I can’t speak to men. We deal with you know a lot and not having a support group makes it more, makes it harder cause we kind of have to deal with everything ourselves or you know, on our own and I would say I think I’m depressed which is it’s something that’s kind of frowned upon or something that’s.

Frowned upon by? Like your friends, your family, your community?

The community. It’s not something that’s in the norm, I guess you would say. I don’t think people are educated on it much.

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Profile Info

Age at interview:

28

Sex:

Male

Background:

Ben lives in transitional housing for formerly homeless people and is looking for work. He has one son. He is Puerto Rican/Hispanic.

…right now I just really need a job. I really, but I get distracted, but I really, I think that’s why I’m losing my mind right now. I’m really depressed because right now, right now at the current time, I think that’s the biggest problem right now, it could be the biggest problem that I’m unemployed. And I have too much free time and I’m actually in jeopardy of like triggering a relapse because you know when you have so much free time you contemplate your thoughts and sometimes you can think negative thoughts and then you can be self-destructive when you have too much free time…

… for over 7 months I have been clean now, but now I have not been able to find employment. And, and that’s, that’s making me depressed because I have nothing to do. I don’t like I’m not, I was a productive, productive member of society and I was working and now I feel very depressed because I don’t have a job and I want to go back to work and do something and make some money.

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Profile Info

Age at interview:

18

Sex:

Female

Age at diagnosis:

11

Background:

Sierra Rose lives in an apartment with her boyfriend, another roommate, and three beloved cats. She spent a week in the hospital shortly before her interview, and was continuing with out-patient care but struggling to pay for some of it. She is Italian and Jewish.

When the depression would kick in , I’d stop caring as much about my job, I figure, “Well what’s the point of it? I’m just a low class American anyway.” I would stop smiling all the time. I’d start brooding.

It makes it extremely hard to hold down a job because I’ll get a job and I’ll be doing great. I’ll be ok and then the depression is like, “Wait you’re happy? No you’re not allowed to be happy.” And it draws me back down into being depressed and then I lose my job because, “Oh, you’re not who you told us you were when we interviewed you. You’re not who you were when we hired you.” It makes it extremely hard to have relationships, to keep a job to do anything…

Prejudice and perception in perspective

A number of people we interviewed said they had found ways of coming to terms with stigma, bias, and other forms of prejudice – and of celebrating their individuality. Some moved to parts of the country (especially on the West coast) where they felt less isolated, found healthier communities, and built networks of people who could support and understand them. Others cultivated commitments to the arts or other expressive practices. (See 'The positive sides of depression'.)

Crystal is an African American college student. She works campus jobs during the year and internships in the summers.

And there are tons of people across you know the sands of time who have struggled with prejudice and perception and everything like that and you’re one of many who go through those issues. And you know how, if you look back in time and at how people have dealt with it, they’ve dealt with it full on force and it’s been a struggle and sometimes it can be painful but they’ve dealt with it and that’s how you have to do it in order to come through to the other side. So adopt the tradition of facing it instead of constantly seeking to avoid it because avoiding it will only put yourself back, in your little comfortable space of being anxious enclosed and everything. And facing it will give you an opportunity to say there’s another side of this.

References
*”Major Depression Among Adolescents.” National Institutes of Health, n.d., Web. 7 February 2016.
*1Pratt, Laura, and Debra Brody. “Depression in the U.S. Household Population, 2009-2012.” National Center for Health Statistics Data Brief 172 (2014).
*2 Brown, Tony N., et al. "“Being black and feeling blue”: the mental health consequences of racial discrimination." Race and Society 2.2 (2000): 117-131.
*3 Williams, David R., et al. "Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life." Archives of General Psychiatry 64.3 (2007): 305-315.
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